NPI | 1205988227 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 0044131) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NJ 35S100221400) |
Enumeration Date | 2007-01-18 |
Last Update Date | 2007-07-08 |